The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Wednesday, October 07, 2009

Australia: Man dies as ambulance searches for a government hospital that will take him

Isn't government-run healthcare great?

A SUNSHINE Coast man died of a heart attack after his ambulance was diverted to a less crowded hospital that was further away, the Queensland Ambulance Service's union said. Paramedics resuscitated an elderly cardiac arrest patient, who had a significant medical history, at Mooloolah on Friday and transported him to Caloundra Hospital. However Australian Liquor, Hospitality and Miscellaneous Workers Union organiser Kroy Day said the ambulance was advised that if they ramped at the Caloundra Hospital there would be a "significant wait" until the patient could be unloaded onto a bed.

He said the ambulance was instead diverted to the Nambour Hospital, which is 10 to 12 minutes further away. "Unfortunately the patient was declared deceased upon arrival," Mr Day said.

Mr Day, who has 20 years' experience as an ambulance officer, said he backed the paramedics 100 per cent as they were forced to make an almost impossible decision. "What we do know is that in cardiac arrests, literally seconds make the difference," he said. "They made the decision on good faith but unfortunately the patient was declared deceased upon arrival. "All I can think is thank god I wasn't the one who had to make that decision."

Queensland Health has argued that QAS did not advise the hospital the man was a Category One cardiac arrest patient and would have accepted the patient had they known.

However Mr Day said Queensland Health were stooping to a new low when it came to excuses. "I am absolutely appalled and disgusted at that excuse," Mr Day said. "The ambulance was travelling to Caloundra Hospital with its lights and sirens on and they knew that. "The paramedics also called the hospital and told them they resuscitated the man. "If nothing else happened the hospital should have worked out that this was a Category One."

Mr Day said Queensland Health was in need of a serious overhaul, citing that in the 2007-08 financial year there were more than 27,000 cases of ambulances waiting to unload their patients for more than 30 minutes.

Canadian province takes away a life-saving drug from those who need it

Opponents of U.S. President Barack Obama's proposed health care reforms have just been handed a powerful talking point by Ontario's government.

Democrats cobbling together the U.S. plan want to include a "public option" -- a taxpayer-funded health-care alternative that would enable Americans to choose between private medical insurance plans or a government-backed system similar to Canada's. Opponents of the public option maintain that Canadian-style health care would entail rationing, caps on care, bureaucratic interference in medical decision-making and even "death panels" deciding when the ill become too expensive to save.

Most Canadians believe this is a gross exaggeration of reality. But then how to characterize Ontario's decision to cut off funding for colorectal cancer patients taking a life-prolonging drug, in order to save $9-million a year? Andre Marin, the province's plain-speaking ombudsman, said the decision "verges on cruelty." Marin said the "arbitrary" limit on the number of cycles of the drug Avastin that Ontario will fund forces patients to pay out of their own pockets or abandon treatment.

Avastin does not cure cancer, but prolongs life when taken in conjunction with chemotherapy treatment, adding, on average, nine months of survival. "For patients whose cancer has already metastasized, it stops their tumours from growing and prolongs their lives, at least for a while. It is, without exaggeration, their lifeline," Mr. Marin said.

Ontario Health Minister David Caplan rejected the suggestion that the cap on treatment was a financial decision alone, arguing it was based on clinical evidence. But it's easy to reach the conclusion that the province decided nine extra months of life for a dying patient wasn't worth the money. Which is pretty much the kind of decision a "death panel" would be confronted with.

Cruel as that example may appear, it does not wholly validate the cause of those opposed to public health care. Private insurance policies commonly place caps on treatment, refusing it altogether for a "pre-existing condition" or cutting off funding just at the point where a patient needs it most. While opponents of the Obama plan denounce the notion of civil servants making decisions on medical care, it's hard to see how allowing insurance company employees to make the same decisions is any better.

Gold-plated insurance plans may eschew caps on coverage, but the cost of such plans necessarily limits them to the wealthy, and even fervent critics of Mr. Obama are unlikely to suggest the rich have a right to live longer than others. But at least the existence of such plans means Americans have a choice between trying to raise the money or accepting the inevitable. The only choice allowed Ontarians in the same situation is to seek treatment in the United States or move to another province, since Mr. Marin says Ontario is the only one of seven provinces funding Avastin that limits treatment.

Several conclusions can be reached from this. No matter what the funding system, medical care involves agonizing decisions that involve variables beyond the simple goal of prolonging life to its maximum duration. Cost is a reality, as is the comparative quality of life that comes with its extension. Doctors may be best suited to make these decisions, but no system can afford unlimited care on a universal basis no matter what the prognosis.

Choice, however, is a good thing. President Obama's preferred model would provide Americans with a choice of public or private care, allowing people to make their own decisions. He may not get his wish, given the strength of his opponents and worries about the budget. But Canadians who are adamantly opposed to any discussion of a private option are from the same camp as Americans who denounce public care as socialism and insist on private care or nothing.

Canadians deserve the right to make the choice, and it's well past time Ottawa and the provinces end the blockade on what could only be a productive discussion.

It seems that our legislators, despite the thousands who showed up at their town halls to protest such measures, despite the tens of thousands attending other TEA Parties across the nation all year and despite the millions attending various 9/12 rallies, still do not understand the message the American people are sending. The American people want government to resume it’s proper, Constitutional role. For a good example, let’s look at the current healthcare debate.

Our legislators continue to insist that “something must be done” to control healthcare costs and that “something” must involve at least a partial government takeover of our healthcare system. Many of them profess alarm at the anger and opposition they are seeing, but refuse to believe that American citizens are rejecting the entire notion of government run healthcare. They often suggest that those who oppose their legislative attempts to take control of the healthcare system are lacking in compassion. Many of them have referred to large segments of the American population in derogatory terms. It is time for them to wake up.

This debate is not just about healthcare, it is about the foundational principles of this republic. The issue is whether or not we, as individuals, have the right to control our own lives and property and to make our own decisions about our healthcare. Doctors are professionals, providing a service that many times costs more than it should because of a system already filled with intrusive, overbearing, needless, bureaucratic, governmental interference. If our legislators are truly interested in lowering healthcare costs, perhaps they should consider deregulation and tort reform. Perhaps they should allow interstate competition for health insurance companies. In other words, they could consider getting the government out of the way and letting the free market work.

For anyone, least of all our elected officials, to suggest that those who oppose government run healthcare are lacking in compassion, when the question before us as a nation has little or nothing to do with compassion for one’s fellow man, is outrageous. Americans donate more of their time and money to charitable and service efforts than the people of any other nation. As was noted in the Seattle Times in a 2007 article: “Americans give twice as much as the next-most-charitable country, according to a November 2006 comparison by the Charities Aid Foundation. In philanthropic giving as a percentage of gross domestic product, the United States ranked first at 1.7 percent. Britain was next at 0.73 percent, while France, with a 0.14 percent rate, trailed such countries as South Africa, Singapore, Turkey and Germany”. Notice that the USA gave more than twice as much as the 2nd place nation.

Government run programs are not known for compassion. Witness Oregon’s response to Barbara Wagener, a woman suffering with lung cancer. The state health plan refused to pay for her cancer drugs, but offered to pay for palliative care, including drugs she could use to commit suicide.

The government is known for corruption and fiscal irresponsibility. The American people are known for compassion and charity.

Listen carefully legislators. Americans as a whole are a compassionate and giving people and we do not want government run healthcare. Americans want the freedom to make our own choices, even if that means we occasionally fail to make good choices. It is not the government’s job to control the choices we make with our freedom, it is the government’s job to make sure we have the freedom to make those choices. The current administration and Congress seem disturbingly unwilling to grant that point, and that is why millions are gathering to peacefully protest the actions of this administration and this Congress.

People are doing a tremendous amount of hand-wringing about the tenor of the national debate. But at least Americans are finally being rude about something that matters. Most of the bad, boorish behavior that Americans increasingly inflict on each other is for selfish reasons or no reason at all. Anyone who has ever been to a professional football game or gone shopping on the day after Thanksgiving surely can’t be surprised that things have gotten a little ugly as we discuss health care and, by extension, our fundamental relationship with our government.

Survivors of an increasingly coarse American society where adults routinely get into fistfights over the athletic exploits of multimillionaire strangers should hardly expect a prep-school debating competition. The man with the vile slogan on his T-shirt or the woman nattering on her cell phone who smashes her sport utility vehicle door into your car inflict their small injuries to civilization only because they’re self-absorbed and ill-mannered. Say what you will about the guy who bit off the finger of the town hall protester, he was passionate about public policy.

America is suddenly a land alive with political debate and policy interest. A recent Pew survey found that 36 percent of adults said they were following the health care debate very closely. Not the breast augmentation of a reality-show mega-mom or the latest celebrity crime, but boring old health care. By comparison, during the debate over the Iraq surge in early 2007, the life-or-death issue couldn’t get past 30 percent.

The reason for the fascination is that voters understand the consequences of government taking dominion over health care. Having Washington in control of how we care for our bodies is frightening to many Americans who normally do their best to ignore Congress. When we consider how the federal government has botched the regulation of our liberties and our pursuits of happiness, it seems daft to hand over our lives to the untender mercies of federal bureaucrats.

We mostly have President Obama to thank for this level of fascination. The 2008 election was the most closely watched in history because of the stakes and the participants. But by trying to use his mandate as a license to re-engineer society, Obama has certainly kept our interest.

And no doubt, the tenor of the dialogue has been coarse and discourteous, even among our leaders. When a freshman member of the House of Representatives has his staff print up signs for a floor speech accusing the other party of wanting sick people to die and then compares the current health care system to the Holocaust, you know the lines of civil discourse have been crossed. But Rep. Alan Grayson is probably just as unpleasant in his personal life as he is in Congress. In fact, his boorish behavior on the floor of the House is probably an improvement over the way he conducted himself as a lawyer and a telecom executive.

Grayson lives in a pink mansion outside Orlando and drives a Cadillac with a “Bush lied, people died” bumper sticker. Do you suppose his neighbors were surprised that he turned out to be an unmannerly attention hound in Congress? Do the people whom Grayson sued over the years think his antics and irresponsible exaggerations are out of character?

Much of the umbrage being taken at Grayson’s bad behavior or the outburst of Rep. Joe “You lie!” Wilson is for effect. Democrats and Republicans have both tried to score points by painting their opponents as cretins. But some of the shock is sincere. Nancy Pelosi fought through tears to say that the anger over her party’s health care plan reminded her of a homophobic rage that she imagines swept through San Francisco prior to the 1978 assassination of Harvey Milk by a deranged fellow politician.

Pelosi’s worries are obviously a bit phony because she wouldn’t punish Grayson the same way she punished Wilson, but she did seem genuinely afraid about a combustible civic atmosphere. Pelosi should take a trip back to her hometown of Baltimore and check out the atmosphere. There were 234 homicides last year and the local football team’s star player took a plea bargain on a murder charge. I’d say the health care debate is an improvement over most of what passes for society these days.

Re-read that headline. I am not making this up. A health care bill exists that would accomplish what the headline says. Moreover, it has been verified by the Congressional Budget Office (CBO), in a letter signed in May 2008 by the office's then-Director Peter R. Orszag, who now directs President Obama's Office of Management and Budget. It's called the Healthy Americans Act (the HAA). It has been fully vetted for years, written in legislative language, scored by the CBO and has substantial bipartisan support. In my Sept. 21 and Sept. 28 columns in this space, I explained the two basic, simple concepts of the HAA:

• Universal coverage, attracting liberal support - i.e., all Americans are required to purchase health insurance just like auto drivers are required to purchase car insurance.

• More consumer choice and private-market competition, attracting conservative support - permitting everyone to purchase their own insurance policies in open, competitive "state exchange" marketplaces, each of which must include the Blue Cross/Blue Shield "Basic" policy, the lowest-tier option available to all federal employees and members of Congress or its functional equivalent.

Under all current Senate and House bills, more than 150 million non-elderly Americans are left with no choice - no access to a "public option," if there is one - since they would be stuck with the employer-provided insurance policy, which they lose as soon as they get laid off.

But under the HAA, all Americans would have a choice - stay with an employer's policy or choose another they consider better. And all would own their own policies, which travel with them wherever they go, whether employed or unemployed. Every individual American, including all poor people, would have access to their state's public exchanges, giving them the purchasing power of huge pools of customers, just like federal employees and members of Congress have, with guaranteed coverage, better rates and expanded choice (not just the health insurance the boss picks).

Private insurance companies will have to sharpen their pencils and offer better benefits and services or lose customers and even go out of business - the power of competition and the private market applied to the insurance industry.

So how is it possible the HAA is deficit-neutral in the first two years and reduces deficits thereafter? Mr. Orszag wrote the following in a May 2008 CBO letter on the HAA proposal: "Overall, our preliminary analysis indicates that [the HAA] would be roughly budget-neutral in 2014 [the first full year of operation after a two-year phase-in]. That is, our analysis suggests that your proposal would be essentially self-financing in the first year that it was fully implemented. That net result reflects large gross changes in the Federal Revenues [increased outlays minus increased savings] that would roughly offset each other."

He offered three reasons.

First, there are the increased revenues from a new payment, called "Employer Responsibility Payments." (OK, I am going to call a spade a spade: It's a new tax.) Those employers who currently are insuring their employees would be exempt from this new tax for the first two years. This is because, under the HAA, during the first two transition years, these employers must give each employee an annual salary increase equal to the cost the employer pays for the employee's health care.

But all other employers who did not provide health insurance for their employees would begin immediately to pay the modest tax. It is not an income tax or a flat excise tax. Rather, is a progressive tax - ranging from 3 percent to 26 percent - based on the average national health insurance premium costs, but tied to revenue generated per employee.

Second, the federal government under the HAA would receive increased tax revenues owing to the conversion of the current $250 billion-per-year tax exemption on employee health insurance premiums to the proposal's standard deduction or tax credit. This is simple math: The exemption of $250 billion worth of income costs the federal government more because higher income-tax brackets are using it, rather than shifting these premium payments, now regarded as income, to the lower standard tax deduction or credit provided for under the HAA.

Third, Uncle Sam will save from $150 billion to $200 billion by exchanging paying for Medicaid and SCHIP to allowing poor people to purchase their own private insurance programs at least as good as the Blue Cross basic federal employee/congressional plan.

However, federal and state governments would still provide any benefits currently under Medicaid/SCHIP not currently provided under such Blue Cross basic plans, so no poor person under Medicaid or SCHIP will receive anything less under the HAA. But they will be treated the same as rich people when they seek medical care - a revolutionary concept that both liberals and conservatives are embracing.

So how does the HAA produce a net surplus of revenues, and thus, reduce the federal deficit, after the first two years?

First, Uncle Sam gets more revenues under the HAA because the amount of the new health insurance "standard" deduction under the HAA would grow at the rate of the general consumer price index (CPI) price inflation, and not at the higher medical inflation rate that increases the cost to the federal government of the current non-taxed insurance premiums paid on behalf of employees.

Second, the value of covered benefits under the minimal requirement of the Blue Cross federal employee/congressional plan would be increased only as does the rise in the per capita gross domestic product, rather than the higher level of health care inflation. Minimally, estimates say that would slow the growth of health spending by 1 percent to 2 percent per year. Remember, Mr. Obama said even if we reduced the inflation in health care costs by "one-tenth of 1 percent per year," that could result in trillions of dollars of savings.

Finally, additional savings for Uncle Sam and the rest of us in health care costs would come from significant structural reforms under the HAA. These include requiring insurance for wellness and chronic-disease management; incentives for cheaper high-deductible policies combined with variants of today's health savings accounts; requiring all insurance companies to maintain electronic medical records; transparent state market exchanges, with customer-friendly "help" agencies in each state.

If it is too late to adopt the full HAA because none of the House or Senate committees gave it serious consideration (for reasons that utterly escape me), then the full Senate should consider the "Free Choice" amendment from Sen. Ron Wyden, Oregon Democrat.

Mr. Wyden's amendment is quite simple: It would allow the 150 million employees who are stuck with the plan offered by their employers to opt out, get a cash payment or voucher, and go shopping, knowing that, at the very least, they can purchase a federal employee/ congressional-type plan.

My question to all House and Senate members and specifically, to Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi: Why not let this Free Choice amendment be debated and voted on?

Everyone reading this column should ask their members of Congress that question.

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Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here